BMC Nephrology最新文献

{"title":"Gender disparity in access to care across the continuum of chronic kidney disease: a systematic review.","authors":"Manudi Vidanapathirana, Dilushi Wijayaratne, Jeremy Ariadurai, Saroj Jayasinghe","doi":"10.1186/s12882-026-05288-z","DOIUrl":"10.1186/s12882-026-05288-z","url":null,"abstract":"<p><strong>Background: </strong>'Gender' as a social construct is increasingly recognized as a determinant of care inequity in chronic kidney disease (CKD). However, a systematic analysis of gender-based disparity in access to care across the continuum of CKD care is lacking. This systematic review aimed to synthesize the global evidence on gender-based disparities in access observed across sequential steps of CKD care.</p><p><strong>Methods: </strong>The review was registered in PROSPERO (CRD420251091356) and conducted following PRISMA guidelines. Four databases (PubMed, Cochrane, HINARI, Embase) were searched for publications from 2000-July 2026. Two reviewers independently screened 1,140 articles and risk of bias was assessed using ROBINS-E. Data were extracted across four aspects of CKD care: (1) diagnosis, monitoring and prescription of guideline-recommended treatment, (2) vascular access, (3) initiation and maintenance of dialysis, and (4) transplantation.</p><p><strong>Results: </strong>Thirty-five studies were included, spanning diverse geographical regions. Women faced consistent disadvantages across the continuum of CKD care. They had lower odds of receiving a diagnosis of CKD or nephrology referral, less frequent monitoring of kidney function, and lower prescription rates of guideline-recommended medications. Among those with kidney failure, women comprised only 38-41% of prevalent dialysis patients and initiated dialysis at lower estimated glomerular filtration rates (8.1-10.1 vs. 10.6 mL/min/1.73 m² in men). Women were less likely to initiate haemodialysis with arteriovenous fistulae (AVF) and less likely to transition to AVF later while prevalent on dialysis compared to men. Throughout the transplant pathway, women with CKD were less likely to have transplantation discussed as an option, referred for evaluation, waitlisted, or transplanted. Both systemic and socioeconomic mechanisms contributed to these disparities.</p><p><strong>Conclusion: </strong>Sex and gender-based inequities systematically disadvantage women across the entire CKD care continuum. These findings highlight the need to integrate policies to ensure gender-equity in the management of CKD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual presentation of membranous nephropathy with primary and secondary features: a case report.","authors":"Aanya Shah, Stephen Baker, Dar B Shah","doi":"10.1186/s12882-026-05290-5","DOIUrl":"10.1186/s12882-026-05290-5","url":null,"abstract":"<p><p>Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults, broadly classified as primary or secondary based on etiology and pathologic findings. We present a single unusual case report of a 75-year-old woman with an 11-year course of MN featuring concurrent characteristics of both primary and secondary disease. On two separate kidney biopsies for the same patient, she demonstrated histopathologic features consistent with Class V lupus nephropathy alongside positive PLA₂R staining - a combination that creates significant diagnostic uncertainty. Despite the overlapping features, the patient achieved remission on two separate occasions using different immunosuppressive regimens: cyclosporine initially, followed by Mycophenolate mofetil and prednisone upon relapse over a decade later. This case contributes to the emerging literature on PLA₂R positivity in lupus membranous nephropathy and highlights the diagnostic and therapeutic challenges clinicians face when primary and secondary MN features coexist. The long-term follow-up and dual treatment response on a single patient reported here add to a limited body of published cases and carry implications for management of this increasingly recognized overlap syndrome.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics, pain trajectories, and outcomes of peritoneal dialysis-related peritonitis: a multicenter retrospective study.","authors":"Yumei Liu, Zejin Zhang, Yuqi Liang, Xiaoling Zha, Tao Xu","doi":"10.1186/s12882-026-05277-2","DOIUrl":"10.1186/s12882-026-05277-2","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis-related peritonitis (PDRP) is a common complication of peritoneal dialysis that can lead to inadequate dialysis, technical failure, or death. The distinct clinical characteristics and outcomes of gram-negative, gram-positive, and culture-negative PDRP remain unclear, limiting the development of optimal management strategies and prognostic assessment for these subtypes.</p><p><strong>Methods: </strong>This multicenter retrospective study included 156 hospitalized patients with PDRP from three centers between January 2020 and June 2025. Demographic, clinical, laboratory, and treatment data were collected and analyzed.</p><p><strong>Results: </strong>In the early phase of PDRP, patients with gram-negative infections showed more severe inflammation than those with gram-positive or culture-negative infections, including higher peritoneal dialysate white blood cell counts on day 1, 3, and 5 (P < 0.05); higher C-reactive protein (142.4 vs. 95.1 vs. 77.1 mg/L; P < 0.05) and procalcitonin (8.9 vs. 1.7 vs. 1.2 ng/mL; P < 0.05) levels, altered iron metabolism (higher serum ferritin: 425 vs. 388 vs. 223 ng/mL, P < 0.05; lower serum iron: 4.6 vs. 7.7 vs. 6.2 ng/mL, P < 0.05); and consistently higher abdominal pain scores from days 2 to 12 (4.5 vs. 3.8 vs. 4.0 to 1.0 vs. 0.4 vs. 0.3, P < 0.05). Mortality did not differ significantly among the three groups. However, treatment failure, defined as catheter removal or death, was significantly more frequent in the gram-negative group than in the other two groups (22.7% vs. 10.9% vs. 0%; P < 0.05). Multivariable analysis revealed that hypoalbuminemia was the only factor associated with mortality, whereas gram-negative infection, elevated C-reactive protein, and hypoalbuminemia were associated with treatment failure.</p><p><strong>Conclusions: </strong>Gram-negative infections are associated with greater inflammation, more severe pain, and higher rates of treatment failure. Although mortality did not differ among the three groups, treatment failure was related to infection type, inflammatory burden, and nutritional status. Further prospective studies are required to confirm these findings.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted-release Budesonide (Nefecon) versus systemic glucocorticoids for IgA nephropathy: a placebo-anchored indirect treatment comparison of randomized controlled trials.","authors":"Jianbo Qing, Wenjie Wei, Junnan Wu","doi":"10.1186/s12882-026-05251-y","DOIUrl":"10.1186/s12882-026-05251-y","url":null,"abstract":"<p><strong>Background: </strong>IgA nephropathy (IgAN) is a leading cause of end-stage renal disease, particularly in East Asia. Although systemic glucocorticoids are commonly used to delay progression, they are associated with significant adverse effects. Targeted-release budesonide (Nefecon) offers localized immunosuppression, targeting the gut-associated lymphoid tissue (Peyer's patches), with the aim of reducing systemic exposure. This study evaluates the efficacy and safety of Nefecon compared to systemic glucocorticoids through a placebo-anchored indirect treatment comparison.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials evaluating Nefecon (16 mg/day), systemic glucocorticoids, or placebo in adults with IgAN. The primary efficacy outcome was annualized preservation of estimated glomerular filtration rate (eGFR), and secondary outcomes included annualized proteinuria reduction and serious infections. Placebo-anchored indirect treatment comparisons were performed using the Bucher difference-of-estimates method. This study was registered in PROSPERO (CRD420261357809).</p><p><strong>Results: </strong>Three independent randomized controlled trials were included. Nefecon improved the annualized eGFR trajectory by 2.95 mL/min/1.73 m² per year compared with placebo (95% CI, 1.68-4.58), whereas systemic methylprednisolone produced an improvement of 2.46 mL/min/1.73 m² per year (95% CI, 0.94-3.99). The placebo-anchored indirect comparison showed no statistically significant difference in eGFR preservation between the two treatments (MD, 0.49 mL/min/1.73 m² per year; 95% CI, -1.62 to 2.59; P_indirect = 0.651). For annualized absolute proteinuria reduction, the pooled estimate for Nefecon versus placebo was -0.26 g/g per year (95% CI, -0.34 to -0.18), compared with -0.69 g/g per year (95% CI, -0.97 to -0.41) for systemic methylprednisolone. The indirect comparison favored systemic methylprednisolone (MD, 0.43 g/g per year; 95% CI, 0.13-0.73; P_indirect = 0.004), although this analysis was exploratory because proteinuria measures and follow-up durations required harmonization. The indirect comparison of serious infections was not statistically significant (RR, 0.55; 95% CI, 0.04-7.16; P_indirect = 0.650).</p><p><strong>Conclusion: </strong>In this indirect comparison, both Nefecon and systemic glucocorticoids were associated with improved kidney outcomes versus placebo in IgAN. No statistically significant indirect difference was observed for eGFR preservation, while proteinuria and safety findings require cautious interpretation. Head-to-head trials are needed to further define their relative efficacy and safety.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of BAFF/APRIL-pathway inhibitors versus placebo in adults with IgA nephropathy: a systematic review with pairwise and network meta-analysis.","authors":"Nada Mansour, Ramy M F Elbarody, Ahmed M Kamel","doi":"10.1186/s12882-026-05267-4","DOIUrl":"10.1186/s12882-026-05267-4","url":null,"abstract":"<p><strong>Background: </strong>B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) drive the galactose-deficient IgA1 (Gd-IgA1) production that underlies IgA nephropathy (IgAN). Several BAFF/APRIL-pathway inhibitors have entered randomized testing, but none has been compared head-to-head.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Scopus, the Cochrane Central Register, Web of Science, and Embase to July 2026 for randomized, placebo-controlled trials of BAFF/APRIL-pathway inhibitors in adults with biopsy-proven IgAN. Random-effects pairwise meta-analysis used the standardized mean change for proteinuria and estimated glomerular filtration rate (eGFR), change-score standardization for biomarkers, and risk ratios (RR) for safety, and a frequentist star network meta-analysis with placebo as reference ranked agents by P-score.</p><p><strong>Results: </strong>Seven trials (1,590 adults) evaluating telitacicept, atacicept, and sibeprenlimab were included. Versus placebo, BAFF/APRIL-pathway inhibition reduced proteinuria (SMCR -0.73, 95% CI -0.88 to -0.58, p < 0.001, I² = 0%) and a small difference in eGFR favouring active treatment (+0.21, 95% CI 0.04 to 0.38, p = 0.016, I² = 0%). Serum Gd-IgA1 and total IgA fell substantially but with high heterogeneity (I² > 95%). Serious adverse events (RR 0.52, 95% CI 0.30 to 0.90) and treatment discontinuations (RR 0.31, 95% CI 0.11 to 0.88) were fewer with active treatment, overall adverse events did not differ (RR 1.03, 95% CI 0.92 to 1.16), and injection-site reactions were more frequent (RR 5.98, 95% CI 2.39 to 14.96). In the network, the exploratory P-score for proteinuria reduction was highest for sibeprenlimab (0.94), with no significant between-agent difference, and atacicept showed the only significant reduction in serious adverse events (RR 0.24, 95% CI 0.08 to 0.70).</p><p><strong>Conclusions: </strong>In adults with IgAN, BAFF/APRIL-pathway inhibitors consistently and substantially reduced proteinuria versus placebo, with a small short-term eGFR difference and no evident short-term safety signal, although longer follow-up is required to define uncommon, infectious, and immunological risks. Whether this antiproteinuric effect, seen over approximately 6 to 12 months, translates into durable preservation of kidney function remains uncertain. The between-agent and biomarker estimates are exploratory, and longer trials reporting kidney-failure endpoints are needed to confirm a disease-modifying effect.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of nephrectomy on liver and contralateral kidney volume in patients with ADPKD; a case series.","authors":"Paul Geertsema, Thomas Bais, Benjamin H J Doornweerd, Maatje D A van Gastel, Esther Meijer, Robert A Pol, Ron T Gansevoort, Niek F Casteleijn","doi":"10.1186/s12882-026-05237-w","DOIUrl":"https://doi.org/10.1186/s12882-026-05237-w","url":null,"abstract":"<p><strong>Purpose: </strong>A substantial number of patients with autosomal dominant polycystic kidney disease (ADPKD) undergo nephrectomy. A decrease in intra-abdominal pressure after nephrectomy might hypothetically accelerate the growth of other polycystic organs and accelerate the rate of eGFR decline of the remaining kidney. In this case-series, we investigated the change in kidney and liver volume in patients before and after nephrectomy, and in a control group without nephrectomy.</p><p><strong>Methods: </strong>In this retrospective case series kidney and liver volumes were measured using an automated stereological approach (MRI) or manual tracing (CT). Additionally, change in eGFR was investigated in patients before and after nephrectomy in whom this procedure did not result in an immediate need to start kidney replacement therapy (KRT).</p><p><strong>Results: </strong>Twelve patients were included in the nephrectomy-KRT group and ten in the KRT-only control group. Kidney volume growth rates before start of KRT were similar between both groups (nephrectomy-KRT: 6.3 [95% CI: 4.0 to 8.4]; KRT-only: 6.7 [3.5 to 9.7] %/year, difference p = 0.8). After start of KRT, kidney volume significantly decreased in both groups (nephrectomy-KRT: -3.7 [-6.3 to -0.7]; KRT-only: -5.2 [-8.9 to -1.3] %/year, difference p = 0.5). The change in liver volume was not statistically different between both groups. In four additional patients in whom nephrectomy did not immediately lead to the start of KRT, the rate of eGFR decline of the remaining kidney did not change after the procedure.</p><p><strong>Conclusion: </strong>In patients who did and did not undergo nephrectomy at the time they reached the need for KRT, kidney volume seemed to decrease after the procedure. In the two patients who had a nephrectomy of a functional kidney without direct start of KRT, nephrectomy did not seem to lead to accelerated eGFR decline of the remaining kidney. Due to the small sample size of this case series, these results have to be validated preferably in a large prospective multicenter study.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with self-advocacy among patients receiving maintenance hemodialysis: a multicenter cross-sectional study using latent profile and network analysis.","authors":"Wenbin Xu, Shujuan Duan, Yuhe Xiang, Jianxia Lyu, Qian Yang","doi":"10.1186/s12882-026-05261-w","DOIUrl":"10.1186/s12882-026-05261-w","url":null,"abstract":"<p><strong>Background: </strong>To explore the current status of self-advocacy among patients undergoing maintenance hemodialysis (MHD) and to identify latent profile characteristics and symptom networks associated with self-advocacy.</p><p><strong>Methods: </strong>A convenience sampling method was used to recruit patients undergoing MHD from three tertiary hospitals in Chengdu between May and July 2024. Data were collected using a general information questionnaire, the Patient Self-Advocacy Scale, the Perceived Social Support Scale, the Self-Perceived Burden Scale, and the Hemodialysis Self-Management Instrument. Latent profile analysis (LPA) was conducted using Mplus 8.3 to identify subgroups of self-advocacy. SPSS 26.0 was used for univariate and unordered multinomial logistic regression analyses to examine factors associated with self-advocacy profiles. Network analysis was performed using R software to reveal the symptom network structure and central node of each subgroup.</p><p><strong>Results: </strong>Self-advocacy behaviors among 429 patients undergoing MHD were classified into three latent profiles: the Self-Advocacy-Passive Acceptance Type (26.5%), the Self-Advocacy-Moderate Participation Type (58.5%), and the Self-Advocacy-Active Striving Type (15.0%). Multivariate regression analysis showed that gender, age, educational level, perceived social support, self-perceived burden, and self-management ability were significantly associated with self-advocacy profiles. Network analysis indicated that the central node of the Passive Acceptance Type was family support, that of the Moderate Participation Type was problem-solving ability, and that of the Active Striving Type was emotional burden. The network structure demonstrated good stability and accuracy.</p><p><strong>Conclusion: </strong>Overall, the level of self-advocacy among patients undergoing MHD was relatively low and exhibited substantial heterogeneity. Healthcare professionals should implement targeted symptom management strategies based on the specific characteristics of different subgroups. These findings may inform interventions based on the Capability, Opportunity, Motivation-Behavior (COM-B) model aimed at enhancing patients' capability, opportunity, and motivation for self-advocacy.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Physical ACtivity Enhancement Scheme (PACES) improves physical activity level and well-being in persons with hemodialysis: a randomized controlled trial.","authors":"Mei Huang, Xiao Zhang, Yanqing Kang, Honghong Lv, Jie Gao, Ya Zhang, Yaodian Liu, Xinyue Xu, Aili Lv, Chunping Ni","doi":"10.1186/s12882-026-05256-7","DOIUrl":"10.1186/s12882-026-05256-7","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of the Physical ACtivity Enhancement Scheme (PACES) on the physical activity levels and well-being of hemodialysis patients.</p><p><strong>Methods: </strong>This is a single-blinded, two-arm, parallel-group, randomized controlled trial. Participants were recruited in September 2022 and randomly allocated to the intervention and control groups at a 1:1 ratio. The intervention group received a 3-month PACES intervention in addition to routine care, while the control group received only routine care. Baseline and post-intervention data were collected via electronic medical records and questionnaires. Daily step count was defined as the primary outcome, and other relevant indicators were set as secondary outcomes.</p><p><strong>Results: </strong>A total of fifty-three participants completed the study. Regarding the primary outcome, the intervention group obtained significant improvements in daily step count compared with the control group after intervention. In terms of secondary outcomes, the intervention group also showed clear advantages in perceptions of exercise benefits and barriers, exercise self-efficacy, utilization of social support, the effect of kidney disease, the burden of kidney disease, the physical component summary, and the mental component summary.</p><p><strong>Conclusions: </strong>These findings suggest that the PACES intervention may improve physical activity level and other health-related outcomes among hemodialysis patients. Given the limitations of single-centre design and relatively small sample size, further multi-centre and large-scale studies are warranted to examine its potential generalizability. This intervention has potential clinical value for helping patients maintain health and improve overall well-being during dialysis treatment.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT05718765. Registered on 24 December 2022. Retrospectively registered.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of renal coordinator referral and risk of unplanned dialysis initiation in advanced chronic kidney disease: a retrospective cohort study.","authors":"H W Tiew, Cathrine M C Kong, Claude J Renaud, Selene T Y Teoh, Sri F B B Saifful, Janice T Z Ho, S M Lau, Grace F L Tan, John H Y Hsu, S-Y Wong, Y K Teh, Allen Y L Liu","doi":"10.1186/s12882-026-05255-8","DOIUrl":"10.1186/s12882-026-05255-8","url":null,"abstract":"<p><strong>Background: </strong>Guideline recommendations on the timing of pre-dialysis care coordination remain largely consensus-based, with limited outcome data supporting specific referral thresholds. This study evaluated the association between the timing of referral to a Renal Coordinator (RC) and the risk of unplanned initiation of dialysis in patients with advanced chronic kidney disease (CKD).</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 282 adults with end-stage kidney disease (ESKD) who were referred to RC at a tertiary hospital in Singapore between January 2022 and December 2024. All patients had established nephrology follow-up before initiation. The primary outcome was unplanned dialysis initiation, defined as initiation without permanent access. Logistic regression and Cox proportional hazards models were used to assess associations between eGFR at RC referral and unplanned initiation, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Of 282 patients evaluated, 237 (84.0%) completed the review by RC, while 45 defaulted post-referral. Unplanned initiation was more frequent among those reviewed at CKD Stage 5 than Stage 4 (78.8% vs. 62.5%). Referral within 90 days independently predicted unplanned initiation (OR 4.21, 95% CI 1.58-11.25). Conversely, RC review at an eGFR of 9-14 mL/min/1.73 m² was associated with a 55% lower risk (HR 0.45, 95% CI 0.22-0.91). Referral at higher or lower eGFR thresholds did not show a significant benefit.</p><p><strong>Conclusion: </strong>Timely RC referral is associated with a reduction in unplanned dialysis. Initiating referral when eGFR is between 9 and 14 mL/min/1.73 m² may provide the necessary lead time to ensure a planned transition to renal replacement therapy.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indirect bilirubin mitigates tubular vacuolization and injury in experimental contrast nephropathy.","authors":"Fatih Ünal, Mehmet Timur Selçuk, Samet Ece, Şefika Karabulut, Candan Altuntaş, Sevil Atalay Vural","doi":"10.1186/s12882-026-05250-z","DOIUrl":"10.1186/s12882-026-05250-z","url":null,"abstract":"<p><p>Contrast-associated acute kidney injury (CA-AKI) remains a clinically relevant complication of intravascular contrast media use, involving complex and incompletely understood mechanisms including oxidative stress, inflammation, apoptosis, and vasomotor dysregulation. Indirect bilirubin has been proposed as a potential cytoprotective molecule due to its antioxidant and anti-inflammatory properties. In this experimental study, twenty-four male Wistar albino rats were randomized into three groups: sham, contrast nephropathy (CN), and contrast nephropathy treated with indirect bilirubin (CNIB). CA-AKI was induced using indomethacin, Nω-Nitro-L-Arginin-Methylester (L-NAME), and iodinated contrast media. Indirect bilirubin (30 mg/kg, intraperitoneal [i.p.]) was administered after injury induction. Renal function was assessed using serum creatinine (SCR), blood urea nitrogen (BUN), and urinary parameters. Histopathological injury was evaluated using semi-quantitative tubular damage scoring, and molecular analyses included inflammatory, apoptotic, and anti-apoptotic markers. Contrast media administration induced significant impairment in renal function and marked tubular injury compared with sham animals. Indirect bilirubin administration was associated with a reduction in histological tubular damage and vacuolization compared to untreated CA-AKI animals. However, improvements in Scr, BUN, and urinary indices did not reach statistical significance. In addition, expression patterns of inflammatory and apoptotic markers were inconsistent between functional, histological, and molecular outcomes, and did not uniformly support a classical anti-inflammatory or anti-apoptotic mechanism. Indirect bilirubin was associated with attenuation of histological renal injury in an experimental model of contrast-associated acute kidney injury; however, this effect was not accompanied by consistent functional improvement or coherent modulation of inflammatory and apoptotic pathways. These findings suggest a potential structural protective signal of indirect bilirubin in renal tissue, while highlighting the need for further studies to clarify underlying mechanisms and functional relevance.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}